title: The effect of adherence to ACLS protocols on survival of event in the setting of in-hospital cardiac arrest.
abstract: OBJECTIVE
  Advanced Cardiac Life Support (ACLS) algorithms are the default standard of care for in-hospital cardiac arrest (IHCA) management. However, adherence to published guidelines is relatively poor. The records of 149 patients who experienced IHCA were examined to begin to understand the association between overall adherence to ACLS protocols and successful return of spontaneous circulation (ROSC).
  
  
  METHODS
  A retrospective chart review of medical records and code team worksheets was conducted for 75 patients who had ROSC after an IHCA event (SE group) and 74 who did not survive an IHCA event (DNS group). Protocol adherence was assessed using a detailed checklist based on the 2005 ACLS Update protocols. Several additional patient characteristics and circumstances were also examined as potential predictors of ROSC.
  
  
  RESULTS
  In unadjusted analyses, the percentage of correct steps performed was positively correlated with ROSC from an IHCA (p<0.01), and the number of errors of commission and omission were both negatively correlated with ROSC from an IHCA (p<0.01). In multivariable models, the percentage of correct steps performed and the number of errors of commission and omission remained significantly predictive of ROSC (p<0.01 and p<0.0001, respectively) even after accounting for confounders such as the difference in age and location of the IHCAs.
  
  
  CONCLUSIONS
  Our results show that adherence to ACLS protocols throughout an event is correlated with increased ROSC in the setting of cardiac arrest. Furthermore, the results suggest that, in addition to correct actions, both wrong actions and omissions of indicated actions lead to decreased ROSC after IHCA.
authors.affiliation: Department of Anesthesiology, Vanderbilt University, Nashville, TN 37232, United States.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: McEvoy
authors.affiliation: Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, United States. Electronic address: field@musc.edu.
authors.forename: Larry C
authors.initials: LC
authors.lastname: Field
authors.affiliation: Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, United States.
authors.forename: Haley E
authors.initials: HE
authors.lastname: Moore
authors.affiliation: Department of Orthopedics, Medical University of South Carolina, Charleston, SC 29425, United States.
authors.forename: Jeremy C
authors.initials: JC
authors.lastname: Smalley
authors.affiliation: Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, United States.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nietert
authors.affiliation: Critical Interventions Manager, Medical University of South Carolina, Charleston, SC 29425, United States.
authors.forename: Sheila H
authors.initials: SH
authors.lastname: Scarbrough
mesh_terms: D022561:Advanced Cardiac Life Support / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Advanced Cardiac Life Support; In-hospital cardiac arrest; Protocol adherence; Quality outcomes; Return of spontaneous circulation